International consensus recommendations for target volume delineation specific to sacral metastases and spinal stereotactic body radiation therapy (SBRT)

Dunne, Emma; Sahgal, Arjun; Lo, Simon S.; Bergman, Alanah; Kosztyla, Robert; Dea, Nicolas; Chang, Eric L.; Chang, Ung-Kyu; Chao, Samuel T.; Faruqi, Salman; Ghia, Amol J.; Redmond, Kristin J.; Soltys, Scott G.; Liu, Mitchell C

doi:10.1016/j.radonc.2019.11.026

Cited by 49 publications

(24 citation statements)

References 28 publications

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“…The technological progress in radiation oncology played a major role in this success and greater precision in the delivery of radiotherapy has allowed the treatment of more difficult cases, which means that a greater number of patients candidates for a SBRT treatment. [4][5][6] Moreover, the adoption of SBRT is no more exclusive of large academic centers and small centers could need help in implementing the physics of SBRT. 8 The challenge of this WG was to help medium/small centers in the physics implementation of this technique.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Furthermore, more recently, international consensus on implementation and practice of SBRT in different regions are appearing in literature. [4][5][6] The adoption of SBRT is growing year by year and many centers worldwide are implementing it. Early clinical studies were typically performed in academic centers within controlled trials.…”

Section: Introductionmentioning

confidence: 99%

“…Its clinical value in terms of high tumor control and low toxicity profile has been demonstrated in numerous studies for both primary and metastatic settings 1–3 . Furthermore, more recently, international consensus on implementation and practice of SBRT in different regions are appearing in literature 4–6 . The adoption of SBRT is growing year by year and many centers worldwide are implementing it.…”

Section: Introductionmentioning

confidence: 99%

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Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Mancosu

Russo

Antonucci³

et al. 2021

Medical Physics

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To report how the adoption of a Lean Thinking mindset in the management of a national working group (WG) on the physics of stereotactic body radiation therapy (SBRT) contributed to achieve SBRT standardization objectives. Methods: Vision for the WG has been established as fragmentation reduction and process harmonization enhancement in SBRT for Italian centers. Two main research themes of the technical aspects of SBRT emerged as areas with major standardization improvement needs, small field dosimetry and SBRT planning comparisons, to be investigated through multi-institutional studies. The management of the WG leveraged on the Lean concept of fostering self-organization in a non-hierarchical environment. Four progressive involvement levels were defined for each study. No specific "scientific" preexperience was required to propose and coordinate a project, just requiring a voluntary commitment. People engagement was measured in terms of number of published articles. The standardization goals have been conducted through a simplified "5S" (Sort, Set in Order, Shine, Standardize, and Sustain) methodology, first considering a phase of awareness (the first three "S"), then identifying and implementing standardization actions (the last two "S"). Results: Since the beginning, 157 medical physicists joined the AIFM/SBRT-WG. Twenty-four papers/reviews/letters have been published in the period 2014-2019 on major radiation oncology journals, authored by >100 physicists (>50% working in small hospitals). Six over 12 first authors worked in peripheral/small hospitals, with no prior publication as first author. These studies contributed to the awareness and standardization phases for both small-field dosimetry and planning. In particular, errors in small-field measurements in 8% of centers were detected thanks to a generalized output factor curve in function of the effective field size created by averaging data available from different Linacs. Furthermore, planner's experience in SBRT was correlated with dosimetric parameters in the awareness phase; while sharing median dose volume histograms (DVHs) reduced variability among centers while keeping the same level of plan complexity. Finally, all the dosimetric parameters statistically significant to the planner experience during the awareness phase, were no longer significantly different in the standardization phase. Conclusions: The experience of our SBRT-WG has shown how a Lean Thinking mindset could foster the SBRT procedure standardization and spread the physics of SBRT knowledge, enhancing personal growth. Our expectation is to inspire other scientific societies that have to deal with fragmented contexts or pursue processes harmonization through Lean principles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Mancosu

Russo

Antonucci³

et al. 2021

Medical Physics

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“…In the absence of such data, expert consensus can provide guidance. Over the last decade, a number of consensus contouring studies to formulate guidelines have emerged for various disease sites (4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Method of Computing Direction-dependent Margins for the Development of Consensus Contouring Guidelines

Lawrence

Chin

Chan

et al. 2021

Preprint

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Background: Clinical target volume (CTV) contouring guidelines are frequently developed through studies in which experts contour the CTV for a representative set of cases for a given treatment site and the consensus CTVs are analyzed to generate margin recommendations. Measures of interobserver variability are used to quantify agreement between experts. In cases where an isotropic margin is not appropriate, however, there is no standard method to compute margins in specified directions that represent possible routes of tumor spread. Moreover, interobserver variability metrics are often measures of volume overlap that do not account for the dependence of disagreement on direction. To aid in the development of consensus contouring guidelines, this study demonstrates a novel method of quantifying CTV margins and interobserver variability in clinician-specified directions.Methods: The proposed algorithm was applied to 11 cases of non-spine bone metastases to compute the consensus CTV margin in each direction of intraosseous and extraosseous disease. The median over all cases for each route of spread yielded the recommended margins. The disagreement between experts on the CTV margin was quantified by computing the median of the coefficients of variation for intraosseous and extraosseous margins.Results: The recommended intraosseous and extraosseous margins were 7.0 mm and 8.0 mm, respectively. The median coefficient of variation quantifying the margin disagreement between experts was 0.59 and 0.48 for intraosseous and extraosseous disease.Conclusions: The proposed algorithm permits the generation of margin recommendations in relation to adjacent anatomy and quantifies interobserver variability in specified directions. This method can be applied to future consensus CTV contouring studies.

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“…Consensus guidelines on CTV/PTV delineation for SRT for unresected spine metastases [19] and resected spine metastases [20] were based upon patterns of recurrence studies. Data correlating pathological microscopic disease to imaging are lacking for sacral and non-spinous bone metastases, but recent expert consensus guidelines provide some guidance in how to define CTV for metastases to these sites, albeit not evidence based [21,22].…”

mentioning

confidence: 99%

A Dose of Reality: Embracing the Unseen to Improve Stereotactic Radiotherapy

2022

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International consensus recommendations for target volume delineation specific to sacral metastases and spinal stereotactic body radiation therapy (SBRT)

Cited by 49 publications

References 28 publications

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Method of Computing Direction-dependent Margins for the Development of Consensus Contouring Guidelines

A Dose of Reality: Embracing the Unseen to Improve Stereotactic Radiotherapy

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